public health and wellbeing briefing - ourcounty...los angeles county department of public health...

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Public Health and

Wellbeing Briefing October 2018


Contents

Introduction ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Governance Context ...................................................................................................................................................................................................................................5

Current Health Conditions and Trends ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Physical Health Outcomes .................................................................................................................................................................................................................... 7

Mental Health .................................................................................................................................................................................................................................................. 13

Community Wellbeing ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Health Wellbeing .......................................................................................................................................................................................................................................... 15

Economic Wellbeing .................................................................................................................................................................................................................................. 16

Social Determinants of Health ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Pollution Burdens and Safety ........................................................................................................................................................................................................... 19

Built Environment ...................................................................................................................................................................................................................................... 25

Health Care ..................................................................................................................................................................................................................................................... 30

Climate Change and Health ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

Draft Goals, Potential Strategies and Indicators ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36

Definition of Key Terms ........................................................................................................................................................................................................................ 36

Draft Goals and Potential Strategies ........................................................................................................................................................................................ 37

Potential Indicators .................................................................................................................................................................................................................................. 40

Cross-Cutting Themes .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

Economy and Workforce Development ............................................................................................................................................................................... 42

Housing and Homelessness ............................................................................................................................................................................................................. 42

Land Use ............................................................................................................................................................................................................................................................ 43

Water ................................................................................................................................................................................................................................................................... 44

Waste and Resource Management .......................................................................................................................................................................................... 44

Transportation ............................................................................................................................................................................................................................................. 44

Energy ................................................................................................................................................................................................................................................................. 45

Landscapes and Ecosystems ......................................................................................................................................................................................................... 45

Climate Change .......................................................................................................................................................................................................................................... 46


Local, Regional, State, and National Targets ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

Local ....................................................................................................................................................................................................................................................................... 47

Regional ............................................................................................................................................................................................................................................................. 49

State ...................................................................................................................................................................................................................................................................... 50

National ................................................................................................................................................................................................................................................................ 51

Endnotes ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53


Introduction The L.A. County Chief Sustainability Office, in partnership with BuroHappold Engineering, UCLA, Liberty Hill

Foundation, Gladstein, Neandross & Associates, and Raimi + Associates, is hosting a series of workshops to

inform Our County, the countywide sustainability plan. Our County is an effort to outline a bold, inclusive vision

for the future that balances the co-equal values of environment, equity, and economy.

At these workshops, we will be discussing public health and wellbeing issues and opportunities for the region, and

will take a deep dive into where and how these topics intersect with equity, air quality, labor, housing, and other

issues. This briefing document is not a plan – it provides background information to inform those workshops and

presents draft goals and strategies as a starting point for discussion.

Place, income, living conditions, and education are all significant contributing factors to the health of a

community. Our health and wellbeing are shaped by genetics, behaviors, and access to quality health care, but

our physical and socio-economic environments also have a profound impact on health outcomes. The wellbeing

of a population incorporates physical, emotional, and social health, reflecting individual physical health and a

community’s sense of opportunity and happiness.

In Los Angeles County, wide health disparities exist in the burden of disease across different socioeconomic

groups. A long history of discriminatory policies, from redlining to occupational exclusions to racially-restrictive

covenants, has disproportionally impacted racial and ethnic groups across the region. How we plan and prioritize

for a sustainable future can determine the health of residents in the long term.

Our future health and wellbeing will also be shaped by climate change. The impacts of more frequent high-heat

days, rising sea levels, intensifying coastal flooding, increased vector-borne diseases, and increasing wildfire risk

will pose threats to communities across the County (and the globe). Vulnerable communities, including the

elderly, people with disabilities, children, people of color, and people with chronic medical conditions will face

increased stresses from climate change, falling disproportionately on those who are historically overburdened

and under resourced. The County can realize co-benefits from climate mitigation strategies, such as improved

health outcomes, increased physical activity, lower greenhouse gas emissions, improved access to multimodal

transportation options, lower energy costs and better resource efficiency.i

The built environment can have powerful impacts on health and wellbeing, shaping community access to services and opportunities through decisions about land use patterns, transportation options, housing quality and affordability, retail choices, pollution levels, and recreational opportunities. This briefing addresses the intersection of these topics broadly, including discussions on health outcomes, the social determinants of health, and climate change.


Governance Context The purpose of this section is to provide a broad overview of the jurisdiction and regulatory framework of the

Los Angeles County Department of Public Health (DPH), which acts as the health officer for unincorporated

areas of the County, as well as 85 out of 88 cities. The cities of Long Beach, Vernon, and Pasadena have their

own health departments.

DPH works to protect the health, prevent disease, and promote the well-being of all persons in Los Angeles

County. As part of its work, DPH assesses community health status and issues, develops policies and plans to

support health, informs and educates people about health issues, enforces laws and regulations to protect the

health of the community, provides health services, evaluates the effectiveness of health services, and researches

new ideas and approaches to health issues in the community. Some examples of the DPH programs and

activities include:

Health needs assessments

Service provision through local clinics, health fairs, and community partners

Health promotion and disease prevention with local partners

Grantmaking to local partners

Climate Change and Sustainability Program

PLACE (Policies for Livable, Active Communities and Environments) and Healthy Design Workgroup

The County works to improve the lives of residents through various services and plays a key role in shaping

positive health outcomes and protecting the wellbeing of residents in the communities it serves.

Oversight of DPH primarily comes from the Los Angeles County Board of Supervisors, California Department of

Public Health, and the Centers for Disease Control and Prevention. The County is divided into eight geographic

Service Planning Areas (SPA), distinct geographic regions that allow DPH to develop and provide targeted

services that meet the local needs of residents (Figure 1). Within its jurisdiction, the DPH has direct control over

data collection and analysis, including vital statistics and public health data, clinical services provided at 14 health

centers across the County, environmental health inspections in homes and businesses, community health

outreach, and dissemination of publications and information updates. DPH has endeavored to address public

health through a racial equity lens and is vigorously focused on eliminating health disparities based on race.

One of those initiatives includes the establishment of the Center for Health Equity.

The work of other organizations and agencies also supports positive health outcomes and mitigation of chronic

disease, including community-based organizations, local planning departments, transportation agencies, health

organizations, and state planning agencies.


Figure 1: Service Planning Areas in Los Angeles County ii


Current Health Conditions and Trends Los Angeles County is a region with vast health disparities. Many cities and neighborhoods within the County are

among the healthiest in California. Other communities, however, struggle with the lowest life expectancies and

highest levels of environmental burdens in the state. This section examines broad health outcomes, including

physical health and mental health.

Physical Health Outcomes

Leading causes of death in a community can highlight a population’s risk factors and offer a promising focus for

policy intervention. Figure 2 illustrates the life expectancy at birth by city in Los Angeles County and Figure 3

illustrates life expectancy in years by race and ethnicity.


Figure 2: Life Expectancy in LA County by City, Unincorporated Area, & Community Plan Area (City) iii


Figure 3: Life Expectancy by Race and Ethnicityiv

Residents in Los Angeles County, the most populous county in the country, can expect to live an average of 82.1

years, but life expectancy across the region reflects a stark reality (Figures 4 and 5). For instance, Walnut Park,

southeast of downtown, has the county’s longest life expectancy, a remarkable 90.5 years, while Sun Village, in

the eastern Antelope Valley, has the shortest at 75.8 years.v

TOP 5 CITY/UNINCORPORATED AREA LIFE EXPECTANCY (YEARS) SERVICE PLANNING AREA

1 Walnut Park 90.5 East (7)

2 Malibu 89.8 West (5)

3 Castaic 88.9 San Fernando Valley (2)

4 Westwood 87.7 West (5)

5 Bel Air-Beverly Crest 87.4 West (5)

Figure 4: Life Expectancy in the Top Five Cities/Unincorporated Areasvi


BOTTOM 5 CITY/UNINCORPORATED AREA LIFE EXPECTANCY (YEARS) SERVICE PLANNING AREA

136 Lancaster 76.4 Antelope Valley (1)

137 Westmont 76.3 South Bay (8)

138 Lake Los Angeles 76.2 Antelope Valley (1)

139 East Rancho Dominguez 76.1 South (6)

140 Sun Village 75.8 Antelope Valley (1)

Figure 5: Life Expectancy in the Bottom Five Cities/Unincorporated Areasvii

Premature death refers to deaths that occur before the age of 75 and are often considered preventable. The

leading cause of premature death in Los Angeles County is coronary heart disease (Figure 6). Air pollution

affects heart health and directly impacts other causes of premature death, including lung cancer, stroke, and

breast cancer. In the coming years, we may begin to see increases in the number of premature deaths due to

environmental challenges, including extreme heat, food and water-borne illnesses, and natural disasters.

CAUSES OF

DEATH

WHITE LATINO/A BLACK ASIAN ALL RACES /

ETHNICITIES

#1 CAUSE Coronary heart

disease

Coronary heart

disease

Coronary heart

disease

Coronary heart

disease

Coronary heart

disease

#2 CAUSE Drug overdose Motor vehicle

crash

Homicide Suicide Homicide

#3 CAUSE Suicide Homicide Lung cancer Lung cancer Motor vehicle

crash

#4 CAUSE Liver

disease/cirrhosis

Liver

disease/cirrhosis

Stroke Stroke Drug overdose

#5 CAUSE Lung cancer Drug overdose Motor vehicle

crash

Breast cancer Suicide

Figure 6: Leading Causes of Premature Death (before age 75 years)viii

While the number of deaths from coronary heart disease have been decreasing across various racial and ethnic

groups in the County, disparities continue to persist (Figure 7). Mortality from coronary heart disease is highest

among Black and White residents and has been consistently higher among both of these groups across the

State. Additionally, hospitalizations for heart attack, heart failure, and stroke are more frequent among African

Americans than any other race/ethnic group.ix


Figure 7: Coronary Heart Disease Mortality Trends by Race/Ethnicity (Age-Adjusted Rate per 100,000)x

Obesity and diabetes, risk factors that impact coronary heart disease. A pattern of high rates of obesity,

diabetes, and coronary heart disease is evident across different geographies and race/ethnicities in the County.

In 2015, 23.5% percent of adults in the County were obese, increasing from 13.6% in 1997 and 22.2% in 2007.xi

There is also a particularly high incidence of obesity, diabetes, and coronary heart disease in communities in the

Antelope Valley and South Los Angeles Service Planning Areas (Figure 8). Among County adults, Blacks (32.9%)

and Latinos (30.9%) had the highest rates of obesity compared with Asians (9.3%). There is also a strong

relationship between obesity, type 2 diabetes, and shared risk factors: age, race, pregnancy, stress, certain

medications, family history, and high cholesterol. The large number of adults with multiple risk factors in the

County suggests that heart disease and stroke are likely to remain among the top leading causes of death,

premature death and disability over the next several decades.

0

50

100

150

200

250

300

2004 2005 2006 2007

All Race / Ethnicity Asian Latino White Black


STATE

OVERALL

LA COUNTY

OVERALL

ANTELOPE

VALLEY

SAN

FERNANDO

SAN

GABRIEL METRO WEST SOUTH EAST

SOUTH

BAY

% OF ADULTS WHO

ARE OBESE 27.9 23.5 29.6 19.8 23.8 22.1 10.3 34.1 28.0 24.1

% OF ADULTS EVER

DIAGNOSED WITH

DIABETES

10.2 9.8 13.9 8.2 9.1 11.6 4.5 12.3 11.2 10.4

CORONARY HEART

DISEASE DEATH RATE

(AGE-ADJUSTED PER

100,000

POPULATION)

92.6 116.7 148.4 118.5 106.6 116.5 87.7 147.5 113.2 122.1

Figure 8: Obesity, Diabetes, and Cardiovascular Disease by Service Planning Areaxii

Over the long term, health disparities can change, but are intimately linked to our early life experiences,

individual behaviors and the social determinants of health. The Antelope Valley and South Los Angeles Service

Planning Areas (Figure 9) magnify the extent of health disparities in the County. The percentage of preterm

births and babies born with low birth weight are the highest in the County and higher than the State.

STATE

OVERALL LA COUNTY

OVERALL

ANTELOPE

VALLEY

SAN

FERNANDO

SAN


SOUTH

BAY

% OF PRETERM

BIRTHS 10.4 9.1 11 9.2 7.5 9.0 7.5 11 9.2 9.2

% OF LOW BIRTH

WEIGHT 8.2 7.0 8.5 7.1 6.0 7.1 6.6 8.4 6.5 7.3

Figure 9: Percent of Premature Births and Low Birth Weight by Service Planning Areaxiii

A high risk exists of overweight and obese youth becoming overweight adults.xiv In the County, obesity rates

among children in grades 5, 7, and 9 are highest in the South Los Angeles Service Planning Area (Figure 10). The

prevalence of obesity across all Service Planning Areas and into adulthood highlights the importance of

addressing health disparities early in life, as poor diet and lack of physical activity are key risk factors for the

leading causes of premature death.


Figure 10: Percent of Children that are Obese in Grades 5, 7, and 9xv

Mental Health

Mental health has a profound impact on an individual’s physical and social well-being, impacting quality of life,

educational attainment, self-care, and level of activity,xvi Poor mental health can contribute to an increased risk

of unhealthy behaviors, health issues, and stress. Understanding that mental health goes beyond a diagnosable

psychological disorder is important, as a person’s quality of life and perceived sense of wellbeing can also

impact a person’s health status.

In Los Angeles County, adults in the Antelope Valley and Metro areas report the highest average number of days

in the past 30 days that activities were limited due to poor mental health (Figure 11). Of the adult population in

the County, 8.6% or an estimated 661,000 persons have been diagnosed with depression. Based on data from the

2015 Los Angeles County Health Survey, rates of depression are above the County and State in the Antelope

Valley (12.5%) and West Los Angeles Service Planning Areas. The lowest values were reported by adults in the

San Gabriel Valley and South Los Angeles Service Planning Areas.

0%

5%

10%

15%

20%

25%

30%

35%

AntelopeValley

SanFernando

San Gabriel Metro West South East South Bay


STATE

OVERALL

LA COUNTY

OVERALL

ANTELOPE

VALLEY

SAN

FERNANDO

SAN


SOUTH

BAY

AVERAGE NUMBER

OF UNHEALTHY DAYS

(DUE TO POOR

MENTAL HEALTH) IN

THE PAST MONTH

NA 3.4 4.2 3.7 3.1 4.3 2.7 3.3 3.1 3.1

% OF ADULTS WITH

CURRENT

DEPRESSION

8.6 8.6 12.5 8.0 6.4 10.8 11.1 8.4 8.3 8.6

% OF ADULTS WHO

RECEIVE THE SOCIAL

AND EMOTIONAL

SUPPORT THEY NEED

NA 64.0 71.5 69.1 55.5 60.2 74.8 55.7 60.7 70.6

Figure 11: Mental Health Indicators by Service Planning Areaxvii

Pressures on time and finances, together with feelings of isolation, can exacerbate psychological levels of stress

across a community. The percentage of adults diagnosed with depression in the County is particularly high

among older adults 60 years+ (20.5%) and adults with a disability (23.6%).xviii Environmental issues can also

complicate existing health issues. For instance, increased air pollution can lead to increased allergies, asthma

attacks, chronic obstructive pulmonary disease, and other cardiovascular and respiratory diseases. Rising

temperatures can also cause premature death, cardiovascular stress or failure, and heat-related illness, such as

heat stroke, heat exhaustion, and kidney stones. Any of these stressors can lead to mental health disorders, such

as depression, anxiety, Post-traumatic Stress Disorder (PTSD), substance abuse, and other conditions.


Community Wellbeing A sense of community wellbeing is defined by physical health, general state of social, mental, and emotional

health, and economic wellbeing. The interaction of these elements’ shapes quality of life, including life

satisfaction and outlook. xix

Health Wellbeing

From a public health perspective, physical and mental health are important elements of overall wellbeing. Of the

adult population in the County, 79% report being in good or excellent health. Based on data from the 2015 Los

Angeles County Health Survey, rates of self-reported good or excellent health are above the County average in

the West Los Angeles and San Fernando Service Planning Areas. The lowest values were reported by adults in

the Metro, Antelope Valley, and South Los Angeles Service Planning Areas. Similarly, adults in the Antelope

Valley, South Los Angeles, and Metro Service Planning Areas report the highest average number of days in the

past 30 days that activities were limited due to poor physical and/or mental health (Figure 12).

STATE OVERALL

LA

COUNTY

OVERALL

ANTELOPE

VALLEY

SAN

FERNANDO

SAN


SOUTH

BAY

% OF ADULTS (18+

YEARS OLD) WHO

REPORTED GOOD /

EXCELLENT HEALTH

STATUS

NA 79 74 83 77 75 90 69 78 79

AVERAGE NUMBER

OF UNHEALTHY DAYS

(DUE TO POOR

MENTAL OR PHYSICAL

HEALTH) IN THE PAST

MONTH

NA 5.9 7.4 5.9 5.9 6.8 5.4 6.0 5.3 5.6

Figure 12: Health-Related Wellbeing Indicators by Service Planning Areaxx

While well-being is generally measured using self-reports, a broad understanding of the social determinants of

health can help us understand the types of factors that impact perceived quality of life.


Economic Wellbeing

Economic wellbeing includes the ability of families and individuals to meet their basic needs, such as food,

housing, and health care, while building long-term financial security and wealth. Higher incomes are associated

with longer life expectancies, a pattern that is evident regardless of where a person lives.xxi Health outcomes vary

based on income and wealth, impacting our access to care, safe homes, high quality food, and even our levels of

physical activity.xxii

Income disparities in Los Angeles County are embedded within the diverse economic landscape. The County is a

hub of innovative industries, a unique confluence of aerospace and entertainment alongside manufacturing,

hospitality, and arts and gaming. The County’s diverse economic landscape also exhibits deep social and

economic disparities. Based on data from the Public Policy Institute of California, 24.3% of Los Angeles residents

live in poverty (2014-2016 average).xxiii Wide income disparities exist, ranging from median earnings of $19,060 in

poorer areas of the County to upwards of $52,687 along the affluent Pacific Coast.xxiv

A Portrait of Los Angeles County 2017-2018 report that median earnings across the County in 2015 were $30,654.

In order to better understand disparities in the County, the report divides the region into “Five LA Counties:”

Glittering LA, Elite Enclave LA, Main Street LA, Struggling LA, and Precarious LA. This briefing will only highlight

income disparities across two of the most disparate counties: Glittering LA and Precarious LA. In the County,

higher median earnings of $52,687 are concentrated in “Glittering LA,” including seven cities along the Pacific

coast, La Canada Flintridge, San Marino, Bel-Air-Beverly Crest, and Brentwood-Pacific Palisades, while lower

median earnings of $19,060 are concentrated in “Precarious LA,” including Cudahy, Westmont, Lennox, East

Rancho Dominguez, Florence-Graham, and Southeast Los Angeles.

While poverty is almost non-existent in Glittering LA (<5%), the poverty rate in Precarious LA is 35.4%, more than

double the countywide rate. Housing only further magnifies these geographic disparities. In Los Angeles County,

4.8% of adults have reported housing instability (i.e., reported being homeless or not having their own place to

live or sleep) in the past 5 years, while in the Antelope Valley (11.3%) and South Los Angeles (9.9%) Service

Planning Areas, that number more than doubles.


Social Determinants of Health The health and wellbeing of Los Angeles County residents is influenced by a wide variety of complex and

interrelated factors. Our behaviors, including what we eat, whether we are physically active or smoke, and how

often we see a doctor affects our health. Our health is also influenced by a myriad of other factors. Economic

stability, environmental pollution and safety, and the surrounding built environment are all factors that shape our

health, as do the individual choices we make about healthy living and wellbeing. Figure 13 illustrates types of

social determinants of health.

Based on the County Health Rankings and Roadmaps, Los Angeles County ranks 23 (of 57 total counties) in

health outcomes, based on how long people live and how healthy people while alive. xxv The rankings also include

a measure based on health factors, including a ranking for physical environment, in which the County ranks last.

These rankings help provide context for the factors shaping health outcomes in the County.

Figure 13: Social Determinants of Healthxxvi


The cumulative burden of social, economic, and environmental conditions may lead to unequal, inequitable, or

disparate outcomes for a region, city, and neighborhood. Figure 14 illustrates a combined measure of healthy

places in Los Angeles County, combining economic, education, transportation, neighborhood, pollution, and

health care indicators. The figure shows a concentration of less healthy places in the City of Los Angeles, North

and Southeast areas of the County, with areas scattered across the San Gabriel Valley and San Fernando Valley.

Figure 14: Healthy Places Index Mapxxvii


Pollution Burdens and Safety

Environmental pollution is costly and inequality distributed across the County. Air pollution, proximity to industrial

pollutants, and water and soil pollution are examples of the types of hazards that impact health. Healthy

communities are safe, clean, and attractive for all members of a community. They include active neighborhoods,

parks, and streets supported by good environmental design.

The burden of environmental pollution varies across Los Angeles County. Children, seniors, people with pre-

existing medical conditions are more vulnerable to the effects of pollution and more sensitive to the impacts.

CalEnviroScreen (CES) is a statewide screening methodology used to help identify California communities that

are disproportionately burdened by multiple sources of pollution and are sensitive to the effects of pollution.

Figure 15 shows the CES scores within Los Angeles County.

Based on 2018 CES data, there are 4,372,397 residents of Los Angeles County that live in a

disadvantaged community.xxviii

There is no one single factor burdening the region. Rather, several environmental, health, and socioeconomic

indicators—including ozone, hazardous waste, cardiovascular disease rate, unemployment and housing burden—

make these communities a priority for future planning, as identified by State Senate Bills 535, 1000, and 379. The

three census tracts with the highest CalEnviroScreen percentile in Los Angeles County are located in zip code

90023, which includes areas of Boyle Heights, Wyvernwood, and Soto Street Junction.

As noted in Figure 6, the leading cause of premature death in Los Angeles County is coronary heart disease. Air

pollution affects heart health and directly impacts other causes of premature death, including lung cancer,

stroke, and breast cancer.


Figure 15: CalEnviroScreen Map for Los Angeles Countyxxix


Air Quality

There are a number of substances that comprise air pollution including solid particles, liquid droplets, and gases,

and these pollutants originate from a variety of sources, large and small. Air pollution sources can be stationary,

such as power plants and manufacturing facilities, or they can be mobile sources, such as motor vehicles. In

addition to primary pollutants which are directly emitted from a source, secondary pollutants can form when

primary pollutants react in the atmosphere. Ground-level ozone is a harmful secondary pollutant that is created

when volatile organic compounds and nitrogen oxides interact in the presence of heat and sunlight.

Compared to most urbanized regions in the United States, L.A. County has a high proportion of toxic emissions

from the energy sector, with oil refineries ranking in the top three of toxic emissions from stationary sources in

L.A. County.xxx Additionally, while there have been major improvements in reducing air pollutants from light-duty

motor vehicles in recent years, heavy-duty vehicles such as trucks, trains, ships and aircraft have not seen the

same kinds of improvements. The table below identifies the most common toxic pollutants from various

stationary and mobile source categories.1

Table 1: Common Criteria and Toxic Pollutants from Stationary & Mobile Sources

Source Pollutant

Refineries Volatile Organic Compounds (VOCs), Lead,

Sulfur Dioxide (SO2), Carbon Monoxide (CO)

Power generation Nitrogen Dioxide (NO2), Particulate Matter (PM), CO

Manufacturing Various carcinogens and hazardous air pollutants

Leakage from natural gas storage facilities Methane, Ethane

Landfill gases Methane, CO2, CO (from flaring)

Metals processing and plating Lead

Paints, coatings, and cleaning materials VOCs

Lawn and garden equipment CO, NO2, VOCs

Dry cleaning VOCs

Wood stove and fireplaces (and No-Burn Alerts) PM, CO

In-home natural gas appliances NO2, CO

1 This list is focused on criteria and toxic air pollutants and does not include carbon dioxide and greenhouse gases.


Light vehicles CO, NO2, VOCs, PM

Heavy vehicles and school buses CO, NO2, VOCs, PM

There are several particularly harmful pollutants which are classified as being in non-attainment (PM10) or

extreme non-attainment (ozone) with the National Ambient Air Quality Standards and serious non-attainment

(PM2.5) with California Air Quality Standards. Ambient air quality also varies geographically; for example,

Lancaster, Santa Clarita Valley, Pomona/Walnut Valley, and East San Gabriel Valley generally have the most

days in exceedance of ozone standards2 throughout the basin.xxxi

Exposure to ozone on a short-term scale can result in human health effects such as shortness of breath,

coughing, inflamed airways, increased frequency of asthma attacks, lungs more susceptible to infection, and can

cause chronic obstructive pulmonary disease (COPD), and other effects. Long-term exposure to ozone may be

linked to permanent lung damage, such as abnormal lung development in children.xxxii Figure 16 displays the

trend in ozone levels within the South Coast Air Basin between the years 2000 and 2016.

The harmful impacts of particulate matters vary with the size of the particle. Exposure to coarser particles, such

as PM10, primarily results in eye, nose, and throat irritation. Finer particles, such as PM2.5, pose the greatest health

risk. These fine particles get deep into lungs and some may even enter the bloodstream. Exposure to these can

affect a person’s lungs and heart, causing cardiovascular illnesses such as cardiac arrhythmias and heart

attacks, and respiratory effects such as asthma attacks and bronchitis.xxxiii Figure 17 displays the trend in ozone

levels within the South Coast Air Basin between the years 2000 and 2016.

Additionally, localized air pollution remains a serious health threat, and one that disproportionately affects

communities that are historically over-burdened and under-resourced. A number of studies have shown that

regional geography, wind patterns, and congested vehicular roadways affect dispersion of pollution. Within 1,000

feet of freeways in Los Angeles County, pollution from traffic is at its highest, as are rates of asthma, cancer,

heart attacks, strokes, reduced lung function, pre-term births, and a growing list of other health problems.xxxiv

2 As measured by days exceeding federal (>0.075 ppm) and state (>0.070 ppm) 8-hour standards


Figure 16: South Coast Air Basin Ozone Trends (2000-2016)xxxv

Figure 17: South Coast Air Basin PM2.5 Trendxxxvi


Toxic air emissions are an effective indicator for air quality, as these types of emissions provide information on

the sources, mass emissions, and spatial distributions of a variety of toxic chemical constituents in L.A. County. Air

toxics risk analyses consider pollutants such as diesel particulate matter, benzene, 1,3 butadiene, and carbonyls.

The SCAQMD has undertaken Multiple Air Toxics Exposure Studies (MATES) in 1998 (II), 2005 (III), and 2012 (IV).

MATES V study is currently in progress (2017-2020). These studies are designed to evaluate progress in reducing

regional air toxics exposure, focus efforts for toxic risk reduction, prioritize environmental justice projects for

funding, address public inquiries regarding air toxics impacts, and help interpret monitoring data from other

special toxics investigations.

Additional special toxics investigations have been performed, including the Paramount Chromium investigations

to identify the source of high chromium levels in local neighborhoods, the Sunshine Canyon Landfill investigation

to mitigate odors emitted from the landfill gases, the Rancho Cucamonga and Aliso Canyon gas leak

investigations to ensure proper clean-up and reduced methane levels in nearby areas, and the Air Toxics

Initiative to expand more generally the remediation of air contaminants within a four county region.

Crime and Neighborhood Safety

Crime and neighborhood safety can have health, social, and behavior implications for victims and their families.

Violent crime, such as homicides, directly affect the health outcomes of communities. In many communities

across the County, homicides are one of the leading causes of premature death and directly impact years of life

lost, as shown in Figure 6. Direct exposure to physical violence is also associated with a range of negative health

consequences, such as depression, anxiety, suicide, and post-traumatic stress disorder.

Along with direct exposure to crime, indirect exposure to crime can have a broad impact on the rest of the

community. An individual’s perception of neighborhood safety can be a disincentive to engage in physical

activity outdoors. Parents who are afraid of neighborhood crime may keep their children indoors and people,

especially women, who fear sexual harassment or assault may avoid outdoor activities, which may limit

opportunities to be physically active and develop support networks.

Most adults (84%) across Los Angeles County perceive their neighborhood to be safe from crime (Figure 16). A

closer look at adult perceptions of neighborhood safety in each Service Planning Area reveals variation across

the region. Adults in the Metro (74.3%), and especially in the South (40.3%) Service Planning Areas, have a lower

perception of safety than most adults in the County. Focusing on a broader understanding of crime prevention

can help address broader community issues, such as gentrification, displacement, and sustainability, that impact

community health and wellbeing.


Figure 18: Adult Perception of Neighborhood Safetyxxxvii

Built Environment

The built environment plays an important role in the health and wellbeing of residents. Land use decisions and

neighborhood design can have significant health impacts. Community characteristics can impact a resident’s

level of physical activity, access to nutritious foods, public safety, and exposure to pollutants. This section

examines the types of environmental determinants that impact a person’s quality of life. Elevating health equity

priorities in making land use decisions can help support a healthy, vibrant, and resilient community.

0%

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90%

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LosAngelesCountyOverall

AntelopeValley

SanFernando

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Metro West South East South Bay


Access to Parks

Park access and quality can have significant impacts on residents’ health and wellbeing. The close proximity of

parks and recreational services can encourage the use of facilities and programming, physical activity, and

mental health benefits. Access to parks in Los Angeles County is generally low and varies widely across the

region (Figure 17). The map does not show park quality, but from a social equity perspective, park amenities (e.g.,

facilities, infrastructure, safety, accessibility, etc.) also impact users’ experience of parks.

Figure 19: Population Living in Los Angeles County Within a Half Mile of a Parkxxxviii

Based on a 2016 study by the Los Angeles County Department of Public Health, park space per capita is highest

in San Dimas (56 acres/1,000 population) and Malibu (55 acres/1,000 population). There are 17 communities with

less than 0.5 acres per 1,000 population.xxxix Income and racial disparities exist in how communities access public

parks across Los Angeles County. Of particular note, African Americans (56%) and Latinos (50%) are more likely

to reside in communities with less park space per capita compared to Whites (27%) and Asians (36%).xl


These disparities signal an opportunity to direct resources and investments to increasing park space and

reducing disparities in health. Increasing park access is expected to be especially challenging in small cities that

have very few undeveloped parcels, requiring creative thinking about design and use of limited community

spaces. Considerations of inclusive park access should also ensure proximity to homes and access to safe,

engaging, and user-friendly facilities with features to accommodate users of all abilities.

Food Insecurity and Access

Food access and security varies significantly across the County. Food insecurity, defined as the inability of

people to access food for a healthy lifestyle,xli steadily increased from 21.8% in 2002 to 30.6% in 2011, and then

leveled off from 2011 to 2015 (29.2%).xlii The Antelope Valley Service Planning Area has the highest level of

households with low food security and households with very low food security (Figure 18).3 The combination of

poverty, low food security, and poor nutrition has serious consequences on the health and wellbeing of all

residents. A lack of quality, nutritious food is closely linked to the incidence of chronic disease and behavioral

health issues.

Figure 20: Households <300% Federal Poverty Level by Food Security Status and Service Planning Areaxliii

3 “Low food security” is defined as households reporting reduced quality, variety, or desirable of diet but little to no

indication of reduced food intake. “Very low food security” is defined as households reporting disruptions in eating patterns

and reduced food intake.

17.9% 18.1% 16.7% 15.7% 15.1%

24.1%19.5% 20.0% 19.6%

11.3%16.3%

10.5%

6.1%

16.9%

6.4%12.9% 12.4%

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LA CountyOverall

AntelopeValley

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Metro West South East South Bay

Low Food Security Very Low Food Security


Access to food may also be limited by conditions in the built environment, including store availability (e.g.,

convenience store, neighborhood market, large grocery store), proximity to a supermarket affordability, and

perceived access to fresh fruit and vegetables. Residents of communities with access to a full service grocery

store or supermarket tend to eat more fruits and vegetables, have lower body weights, and lower rates of

chronic diseases.xliv A strong link exists between the neighborhood retail food environment and the prevalence of

obesity and diabetes, which is of particular concern for low-income communities.xlv In addition, areas with more

fast food restaurants and convenience stores than grocery stores experience higher rates of obesity and chronic

disease across all income groups.

Developed by the CDC, the modified Retail Food Environment Index (mRFEI) identifies the proportion of healthy

and less healthy food retailers within a given geographic area. Scores range from 0-100. Areas with a low mRFEI

score typically lack access to healthy food retailers, including supermarkets, larger grocery stores, and small

produce stores, and may have a higher number of fast food restaurants and convenience stores. An index score

greater than 30 is considered high access to healthy food, while a score of zero identifies no access to a healthy

food retailer.

Geography and population density pose limitations to the use of the mRFEI tool, as some areas that appear as

having no healthy food outlet may have very small populations or large areas of open space. Within Los Angeles

County, there are wide swaths of the region, primarily in the San Gabriel Valley and Antelope Valley, that appear

to have no healthy food retailers (Figure 19). There is also a pattern across the County of communities with high

access to healthy food in close proximity to communities with low or poor access. These neighborhood

disparities in access to healthy food are a major health issue, particularly in disadvantaged communities, where

poor nutrition and unhealthy diets are risk factors for various chronic diseases.


Figure 21: Food Environment Index (mRFEI)xlvi


Health Care

Having health care insurance is one important factor in accessing health care. The Affordable Care Act (ACA)

was passed in 2010, requiring all insurers to offer coverage to individuals regardless of health status. The law

requires that almost everyone have health insurance, or otherwise, pay a tax penalty. California created its own

state-based insurance marketplace, called Covered California, and expanded Medi-Cal to low-income single

adults with incomes below 138% of the federal poverty level.xlvii

The uninsured rate has steadily decreased under the ACA, peaking in 2011 at 28.5% and sharp ly declining to

11.7% in 2015 (Figure 20).xlviii The decline in the number of uninsured was accompanied by an increase in

adults insured by public insurance. If repealed, the County of Los Angeles would see 1,160,501 of low-income

adults enrolled in Medi-Cal lose their health insurance, in addition to 322,700 low- and middle-income residents

losing their federal subsidies.xlix As the provider of last resort, this would create a tremendous strain on the

County hospital system.

Figure 22: Adult (18-64) Insurance Typesl

The availability of services, quality of health care, and potential costs are also important factors in promoting

and maintaining access to care. These barriers to health can lead to delays in receiving care, financial burdens,

and preventable hospitalizations. In Los Angeles County, the highest percentage of adults reporting difficulty

accessing care are concentrated in the South Los Angeles Service Planning Area (Figure 21). This Service

Planning Area is also burdened by the highest percentage of both uninsured adults and adults who did not see a

dentist or go to a dental clinic in the past year in the entire County.li


Figure 23: Percent of Adults Reporting Difficulty Accessing Care by Service Planning Arealii

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Climate Change and Health Climate change is a critical environmental challenge and poses significant threats to the health and wellbeing of

communities across our County. Everyone will not experience the impacts of climate change in the same way.

The impacts of climate change will fall hardest on those who are historically over-burdened and under-

resourced. In these neighborhoods and communities, factors ranging from disproportionately poor

environmental quality, lack of health care access, and linguistic isolation, will contribute to greater climate risk.liii

The burden is compounded by having fewer resources to prepare for or recover from the impacts of climate

change. In responding to the risks of climate change, the County has an opportunity to address climate

vulnerabilities, while building more equitable communities in adapting to changes in the built environment,

natural ecosystems, and economies.

In Los Angeles County, extreme heat, poor air quality, sea level rise, regional drought, vector-borne disease,

among other climate hazards are anticipated to negatively affect human health, health behaviors, and the

socioeconomic factors that influence health outcomes. Figure 22 illustrates the relationships between climate

drivers and health.

Figure 24: Climate Change and Healthliv


For example, extreme heat and multi-day heat waves can directly impact human health, deaths, and illnesses,

while also impacting communities indirectly through energy disruption, spikes in energy prices, and subsequent

inability of lower-income populations to afford basic services. As show in Figure 23, the number of extreme heat

days is expected to increase in many inland areas of the County. Certain populations, such as older adults,

young children and infants, pregnant women, and people with chronic illnesses, are more susceptible to warmer

temperatures and heat-related illnesses.

Figure 25: Extreme Heat Days in Los Angeles County by 2050 lv


Lower-income communities and communities of color are also more susceptible to the effects of extreme heat

due to existing social inequities. Lower-income areas and communities of color are more likely to live in urban

areas lacking sufficient park space or tree canopy coverage, and are therefore, more prone to suffer from urban

heat island effect, which increases the magnitude of extreme heat events. Outdoor workers, individuals who have

limited transportation options, or families who live in lower-quality housing are also at greater risk to extreme

heat. Figure 24 shows example risk factors and contributing causes to extreme heat risk.

Figure 26: Extreme Heat and Healthlvi


Across Los Angeles County, most adults share concerns over the possibility of increased climate change impacts,

including heat waves, wildfires, and droughts and water shortages (Figure 22).

Figure 27: Concern with Climate Change Impacts by Service Planning Area lvii

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Heat Waves Drought Wildfires


Draft Goals, Potential Strategies and Indicators

The following are the major goals and some of the potential strategies in support of public health and wellbeing.

While there are hundreds of possible strategies, we have focused on those that will benefit most from

collaborative planning and implementation across the County. We also intend for each goal to have a focus on

equity, so as to reduce disparate outcomes experienced by disadvantaged communities, particularly low-income

communities of color, with respect to benefits, resources, and impacts. Additionally, public health and wellbeing

goals and strategies must take resilience into consideration, including but not limited to the impacts of a

changing climate. Economic benefits and risks are also key concerns. Please note that these goals and strategies

are presented as a basis for discussion at the Public Health and Wellbeing workshop; we anticipate that they will

be edited (including potentially removing or adding items) as a result of stakeholder input.

Definition of Key Terms

Term Definition Example

Organizing

Principle

A core value at the heart of the plan - the

“why"

Nurturing Healthy Communities

Goals Broad, aspirational statement of what we

want to achieve

Improve transportation-related health and

safety outcomes

Strategies

Approach or approaches that we take to

achieve a goal

Employ strategies to mitigate the negative

health effects of transportation on

adjacent neighborhoods

Actions Specific policy, program, or tool we take to

achieve a strategy

Accelerate the electrification of freight

vehicles

Indicators Quantitative and qualitative measures

used to assess performance

Air quality (PM 2.5, ground level ozone)

Targets Levels of performance that are sustainable 50% reduction from baseline year


Draft Goals and Potential Strategies

Goal A. Eliminate racial disparities in health outcomes by supporting policies that advance

equity.

Potential Strategies:

Target public health resources in communities with the highest health disparities and at the greatest risk to the health impacts of climate change

Partner with neighborhood-based organizations to engage residents around public health, equity, sustainability, and climate change and seek funding for neighborhood-driven project implementation.

Develop a community-based model for sharing in decision-making on public health and sustainability policies and programs.

Use an equity-based framework to review and revise existing policies and programs.

Manage community centers that serve flexible functions, including chronic disease management, prevention services, and resilience hubs.

Implement the Center for Health Equity’s Action Plan.

Goal B. Improve collection, accessibility, and evaluation of public health data by adopting a

racial equity lens.


Systematically collect and disaggregate health data to lift up reveal health inequities across groups.

Use storytelling and infographics to publish and disseminate health and wellness materials in ways that bring data to life.

Partner with local and regional agencies and organizations to evaluate social vulnerabilities, including development of urban heat island maps, community mapping of assets, and health outcomes.

Conduct a detailed vulnerability assessment of disadvantaged communities, including infrastructure risk, health promotion and disease prevention, and specific actions and resiliency policies.

Develop air quality monitoring networks (prioritized in disadvantaged communities) with publicly available data. Utilize this data to identify hotspots of pollution.

Continue supporting individual and community air quality monitoring, which is beginning to occur with inexpensive air quality monitors.

Seek opportunities for partnerships with AB 617 communities, California Air Resources Board, and USEPA.

Develop pilot projects to evaluate findings about community needs, climate preparedness, and public health strategies at the neighborhood scale.


Goal C. Improve community communication by developing a place-based climate change

education partnership.


Support community engagement campaigns that promote education and outreach programs to prepare residents for sustainability challenges, including health promotion and disease prevention, adaptation strategies, and emergency preparedness.

Work with community leaders, civic groups, neighborhood associations, and community-based organizations to connect with hard-to-reach populations.

Co-facilitate an open, ongoing dialogue based on healing and learning to address race and advance healthy equity.

Cultivate community leadership pipeline to lead educational sessions about preparedness planning, sustainability resources, and training available to protect themselves.

Dedicate time to building local partnerships and learn from community members methods for increasing understanding, communication, accountability, and trust with local government.

Goal D. Build a County that supports inclusion, health and wellbeing for all residents.


Implement land use, housing, and transportation patterns that promote access and support compact mixed-use development, housing affordability, and active transportation.

Ensure future development considers the diversity of users in the community, local health context., and strategies for promoting equitable development.

Expand park funding and access, striving for an equitable distribution of park space in the County.

Develop regional partnerships that support healthy food access and improve food security.

Require healthy building design and construction responsive to the potential impacts of climate change.

Expand resources for the County’s Healthy Design Workgroup

Goal E. Enhance health equity by addressing racial equity and environmental pollution.


Partner with community-based organizations to develop and prioritize environmental justice programs and policies to protect human health and welfare.

Work with regional agencies and local partners to strengthen air quality regulations and improve enforcement of existing regulations to protect human health and welfare.

Implement land use, zoning, and building regulations that minimize the exposure of sensitive populations to stationary and mobile sources of emissions.

Ensure the community has access to clean and affordable water.


Properly close idle and improperly abandoned wells and create requirements for capturing emissions from abandoned or idle wells.

Provide incentives for electrification of in-home natural gas appliances, while being aware of differences in the cost of electricity versus natural gas for the same service.

Remediate and redevelop brownfield sites.

Expand pilot programs like the County’s GreenZones program and the City of Los Angeles’s Clean Up Green Up program.

Coordinate affordable housing preservation programs with strategies to mitigate and eliminate environmental exposure from air pollution, out-of-date plumbing, and other sources of pollution.

Goal F. Accelerate the transition to sustainable alternatives to fossil fuel for transportation,

manufacturing, and energy production.


Develop and support zero emission vehicle technology.

Set County-level targets for zero and near-zero emission vehicles, transit, and goods movement.

Provide low-cost, reliable, and clean mobility alternatives to privately owned vehicles.

Increase access to electric vehicles in disadvantaged communities through vehicle sharing, incentives, charging infrastructure, and education.

Incentivize the electrification of goods movement vehicles and equipment, particularly along the 710 corridor, with a priority on assisting independent truckers to finance non-polluting vehicles.

Upgrade the entire County transportation fleet with zero emission vehicle technology.

Transition to 100% renewable energy resources.

Advocate for the continued adoption of clean renewable energy through the Clean Power Alliance, as well as through municipal and private utilities.

Support the development of clean energy technology businesses, especially those providing sustainable jobs in zero emission vehicle manufacturing, operations, and maintenance.

Goal G. Improve access to educational and employment opportunities .


Invest in affordable early childhood education programs.

Collaborate with regional economic development organizations, local governments, and community-based organizations to develop a comprehensive job training and placement program, leveraging sustainability and climate change initiatives.

Expand youth training and employment programs that connect job seekers with high growth industries.

Partner with local community development partners to support wealth building strategies, including local entrepreneurship, collaborative development opportunities, local hiring and procurement, and inclusive workforce development pathways.


Potential Indicators

All indicators apply to L.A. County unless otherwise stated.

Public Health

Overall Health Conditions, Chronic

Disease, Behaviors

Life expectancy at birth

Years of life lost

Obese adults

Low birthweight infants

Adults with depression

Adults who meet guidelines for physical activity

Community Wellbeing

Adults in good or excellent health

Average number of unhealthy days

Poverty

3rd Grade Reading Level Proficiency

Health Care

Access to care

Health professional shortage areas

Cost of care

Environmental Health + Climate

Change

CalEnviroScreen

Environmental Justice Screening Tool

Asthma Cases

Heat Vulnerability Index

Cooling Centers

Homeless Housed in Emergency Shelters

Heat Stress-Related Emergency Department Visits

Cases of West Nile Virus

Motor Vehicle Collision Fatalities and Severe Injuries

Built Environment

Food Security

Healthy Places Index

Households Enrolled in CalFresh


Modified Retail Food Index (for CA)

Perception of Neighborhood Safety

Air Quality

Ambient Air Quality Ozone, PM2.5, and PM10 levels

Overall air toxics risk and diesel risk

Air Pollution Emissions

Large stationary source toxic emissions

Mass emissions of pollutants from mobile sources

Cancer risk associated with diesel mobile sources

Emissions Reduction Efforts

(Countywide) Compliance with rules and regulations by SCAQMD permitted facilities

Emissions Reduction Efforts

(County Operations)

County adoption of Near-Zero and Zero Emission Vehicles into its

fleet

Air Quality, Jobs and Economy Economic cost of air pollution


Cross-Cutting Themes

Economy and Workforce Development

Improving access to financial preparedness and wealth-building tools, including access to affordable and stable housing and business development opportunities, is vital to building community health and economic resilience. The deep racial and ethnic differences in wealth across the Country demonstrate the extreme financial vulnerability faced by some nonwhite households. U.S. Black and Mexican households have 1 percent of the wealth of whites in Los Angeles—or one cent for every dollar of wealth held by the average white household in the metro area.4

Creating jobs and income creation opportunities that develop skills, promote inclusive hiring, and support high-growth industries, can lead to many benefits. In Los Angeles County, employment in educational services (private), health care, and social assistance are projected to add the most jobs by 2024.5

Targeting planning dollars on programs that protect local jobs and housing for communities with the highest level of vulnerability can protect economic benefits for working-class communities, while supporting anti-displacement housing policies, health, and local jobs programs.

With the enforcement of air quality and health-related requirements, it is important that manufacturing and industrial facilities are not shut down resulting in many lost jobs but are rather encouraged to use less hazardous materials such as Lead or integrate more sustainable processes into the facilities.

Improving air quality in L.A. County has the potential to improve the health conditions of outdoor laborers and to reduce the number of sick days of those workers exposed to air quality issues and other pollutants as well as those disadvantaged residents that live in areas with previously high concentrations of harmful pollutants.

Zero emissions vehicle technologies, a method for improving air quality in the County, require workforce training to prepare workers for new opportunities in the advanced transportation sector.

Housing and Homelessness

Nearly 60,000 people are homeless in Los Angeles County, a significant spike from 2016. In 2017, Los Angeles County voters approved Measure H to fund services and programs to prevent and combat homelessness in the County. The initiative will fund housing, mental health, substance abuse treatment, social services, and rigorous accountability.

Los Angeles is among the most rent-burdened cities in the entire nation. More than half of renters spent more than 30% of their household income on rent each month and the availability of affordable rental options is limited across the entire region.6 At the County level, lower income renters are significantly


cost burdened and there is a shortage of 544,000 rental homes.7The County Board of Supervisors passed initial legislation capping rent increases at 3% while strengthening eviction laws.lviii Cost-burdened households have to make difficult decisions that impact health outcomes, such as the inability of lower-income populations to afford health care services.

The number of gentrified neighborhoods (census tracts) in Los Angeles County increased by 16% percent between 1990 and 2015.8 Gentrification can lead to housing burdens, employment instability, displacement, and negative health outcomes. Displacement and residential instability are linked to negative health and social outcomes.9

In L.A. County new housing developments continue to be built within 1000 feet of freeways despite clear evidence that such distance can cause severe harm to one’s health. Recently, a low-cost housing development for seniors was constructed within 500 feet of the 5 freeway. Considering air quality risks and health conditions, residential developments such as these should not be built in such close proximity to freeways and other highly trafficked roadways.

Vulnerable populations, particularly people experiencing homelessness and those living in poor housing conditions without access to air conditioning, weatherized buildings, or quality transportation to escape oppressive conditions may be at greater risk for health impacts from these events. Increased energy demand during heat events can cause brownouts and blackouts, which creates additional vulnerability.

Disadvantaged communities are more likely to experience the effects of indoor air pollutants from poor housing quality.

Land Use

Land use decisions have significant health impacts. The County’s Healthy Design Ordinance promotes the principles of Livable Communities, including increased physical activity, conservation of natural resources, multimodal transportation, and public places. Elevating health equity priorities in making land use decisions can help support a healthy, vibrant, and resilient community.

The cumulative impacts of pollution have been found to be high in specific Los Angeles County neighborhoods. These “toxic hot spots” have high levels of pollution from stationary and mobile sources that elevate health risks. In close proximity to these sources of pollution, these communities have land uses, such as schools, day care facilities, parks, senior housing, and health care facilities that serve populations sensitive to pollution, such as children and seniors.10

Neighborhoods can be designed to enhance human and environmental health. In 2016, Los Angeles County voters approved three major ballot measures: Measure A to fund parks and open space, Measure M to increase investments in active transportation and expand public transit, and Measure JJJ to create new affordable housing. There is a monumental opportunity for Los Angeles County opportunity to ensure future land policies support health equity.


Water

Poor water quality poses serious health risks. Investments in green infrastructure and stormwater retention can increase the number of projects that capture water for reuse and improve water quality and provide recreational opportunities, while reducing the risk of flooding and stormwater pollution. Stormwater and urban runoff across the LA region is highly polluted with a mix of toxic contaminants, many of which are harmful to human health. This runoff enters receiving waters like rivers, lakes, streams, and the ocean, posing a threat to people recreating in these waterbodies.lix

Access to quality drinking water is critical to public health. All water, regardless of source, contains some contaminants. Residents concerned with the quality of the County’s drinking water are turning to bottled water, which has a sizeable carbon footprint. Exploring integrated water management systems provides an opportunity to better manage public resources, incorporate health equity provisions, and support innovative policy and systems change.lx

Waste and Resource Management

Landfills and waste management facilities in regions tend to be concentrated in relatively lower income communities, which are often made up of minority populations.lxi Continuing to reduce waste and reliance on landfills, and ensuring that waste processing facilities operate with as minimal impacts as possible, can help reduce the disproportionate environmental impacts already borne by disadvantaged communities.lxi

Transportation

A person’s travel behavior has both positive and negative effects on health and wellness. An over-reliance on private cars contributes to higher rates of air pollution and respiratory illness.lxii Streets that are not built for or that do not accommodate pedestrians and cyclists encourage higher vehicle speeds,lxiii which in turn contribute to more severe collisions that cause injuries and fatalities.lxiv Streets that accommodate all modes of travel tend to be safer streets, while also encouraging physical activity and reducing air pollution and greenhouse gas emissions.lxv

Vision Zero strategies that focus on improvements to a multimodal transportation system can have profound impacts on land use development and health outcomes. Multimodal strategies can support economic growth, community health, and GHG reduction. Long-range planning documents, including the Southern California Association of Government’s Regional Transportation Plan and Metro’s First Mile Last Mile Strategic Plan, provide important frameworks for integrating health and active living strategies. Shorter term action plans and designs for street redesigns by local government

Metro is an important partner and leader in activating the County’s transportation network and enhancing the use of public transit. Coordinated regional transit projects can ensure allocation of project investments and health benefits to the most vulnerable communities. Role of local governments in road design.

The consolidation of state and federal funding to support active transportation will generate nearly $1 billion dollars over the next decade for active transportation projects.lxvi Investments include the creation of safer roads, new trails, and enhanced connectivity to neighborhoods, transit, and parks. Currently, a proposition to repeal the measure is on the ballot for the November 2018 election.

There is a growing goods movement throughout the County. Regional truck vehicle miles traveled (VMT) are estimated to increase by over 80% by 2035, relative to a 2008 baseline, growing from 6.8% of total VMT in 2008 to 10% by 2035.lxvii This is driven by growth in container shipping and threatens to


worsen congestion on the region’s highways and railways, as well as worsening the freight system’s impacts on health and quality of life unless there is significant improvement in pollution control strategies.

Many of the trucks, ships, and locomotives that are used for goods movement are powered by diesel engines which generate pollutants that affect adjacent communities, which are predominantly low-income communities of color.

Idling can have a severe impact on air quality, releasing harmful nitrogen oxide and carbon dioxide emissions, especially dire in close proximity to populated facilities such as schools, residential areas, and commercial districts.

In the effort to electrify vehicle fleets, those vehicles that service sensitive land use areas such as residential, schools, and day care facilities should be given priority to more aggressively reduce pollutants and improve air quality.

Energy

Energy efficiency can have co-benefits for health, including reductions in air pollutants, fossil fuels, and reductions of costs. Reducing energy usage is a good first step to reducing air pollution and an opportunity to align efforts with state and federal clean air regulations.

Prioritizing investments in expanding renewable energy, storage capacity, and emergency backup systems can contribute to modernizing the power grid. For instance, community solar and energy efficiency programs can contribute to a more resilient power grid during extreme heat events and lessen the risk of future power outages, which have serious health implications for those who depend on medical equipment or air conditioning.

Regional and state partnerships can help accelerate the shift to renewable energy and energy-efficient solutions, which can ensure a more reliable energy supply and reduce air and climate pollution from fossil-fuel power plants. In September 2018, Governor Brown signed into law a mandate for 60 percent renewable energy by 2030 and 100 percent carbon-free energy by 2045, making California the second state (after Hawaii) in the country to legally commit to 100% clean energy.lxviii

Oil and gas development in the Los Angeles Basin presents public health and safety concerns because some oil and gas reserves lie beneath densely populated urban areas. While some facilities have been subject to stricter design and mitigation measures, others have not been required to conduct health risk assessments or other environmental studies. In some neighborhoods, such as South Los Angeles, residences are located only several feet away from the boundary of a drilling site and as close as 60 feet

The transition from natural gas power plants to renewable sources will drastically improve the air quality conditions in LA County, especially in disadvantaged communities that live near such power plans and related facilities as well as reduce the potential for leaks and related toxic emissions, air quality and health issues.

Landscapes and Ecosystems

Extreme heat events and drought decrease soil moisture and increase plant mortality contributing to wildfires and poorer air quality


Plentiful vegetation has the potential to significantly improve air quality acting as filters to remove gaseous pollutants However, poor air quality deteriorates the lifespan and growth potential for vegetation with increasing exposure to sulfur dioxide (SO2) and ozone (O3).

Climate Change

Air quality challenges are exacerbated by climate change, and thus are expected to significantly worsen over the next few decades. Temperatures in L.A. County are expected to continue rising, leading to accelerated ozone production and higher ground-level concentrations potentially offsetting expected emission reduction progress and its positive effect on air quality. It is estimated that ozone could increase to nearly 5 – 10 ppb in L.A. County by the year 2050 while the number of days each year with ozone levels over 90 ppb could increase by 22 – 33 days.lxix Ground-level ozone is associated with various health effects such as reduced lung function, pneumonia, asthma, cardiovascular-related morbidity, and premature death.

Anticipated changes in meteorological conditions under climate change will affect future air quality such as increased periods of stagnation and pollution buildup. Additionally, as climate change continues, Southern California is expected to receive suffer from more frequent and longer droughts, creating more dust and wildfires, both of which raise levels of airborne particulates leading to hospitalizations for illnesses including asthma, acute bronchitis, chronic obstructive pulmonary disease, and pneumonia.


Local, Regional, State, and National Targets The following are examples of existing local, regional, state, and national frameworks that establish targets for

addressing health, wellbeing, and air quality. While there are hundreds of possible strategies, we have focused on

those that will benefit most from collaborative planning and implementation across the County. We also intend

for each goal to have a focus on equity to reduce disparate outcomes experienced by disadvantaged

communities, particularly low-income communities of color, with respect to benefits, resources, and impacts.

Additionally, public health and wellbeing goals and strategies must take resilience into consideration, including

but not limited to the impacts of a changing climate. Economic benefits and risks are also key concerns. Please

note that these goals and strategies are presented as a basis for discussion at the Public Health & Air Quality

workshop; we anticipate that they will be edited (including potentially removing or adding items) as a result of

stakeholder input.

These documents are not inclusive of all efforts across the County. Instead, they offer a snapshot of how local,

regional, state, and national agencies are integrating targets within broader health equity frameworks.

Local

LA County Department of

Public Health Strategic

Plan 2018-2023

This Plan establishes a blueprint to promote health equity. Targets include

implementing at least three new or modified administrative practices and

programmatic activities for each of the following: collaborating with community

partners to identify DPH, local, and state policy changes that promotes racial

equity by December 31, 2020; and connecting Health Agency patients to

services including community resources for chronic disease management, and

permanent medical homes, by June 30, 2020.

A Portrait of Los Angeles

County

This Report provides an in-depth analysis of inequities across the County. It

adopts the American Human Development Index, a measure of wellbeing, to

narrate the story of the County’s people, places, and critical issues. The analysis

concludes with a series of goals and recommendations to boost the County’s

Human Development Index score and narrow racial and ethnic disparities,

including: reducing violence, investments in vulnerable communities, health

improvements, and educational equity.


LA County Health Center

for Health Equity Action

Plan

The Center for Health Equity is an initiative led by DPH, in collaboration with the

Departments of Health Services and Mental Health. The Center worked in

partnership with local partners to prepare an Equity Action Plan, outlining a set

of goals, strategies and objectives for 2018-2023 to reduce and eliminate health

inequities across the County. The work is organized around 5 strategic priorities:

reduce/eliminate gaps in health outcomes, provide useful and inclusive data,

support policy and systems change, cultivate public, private, and community

partnerships, and strengthen organizational readiness and capacity.

LA County Community

Climate Action Plan

The County developed a Community Climate Action Plan (CCAP) in 2015 that

provides a framework for reducing emissions in the unincorporated areas of

the County by at least 11% below 2010 levels by 2020. The Plan lays out four

significant climate change effects that impacts public health, including:

increases in ambient temperatures, increases in extreme heat conditions,

increased frequency, intensity, and duration of extreme storms, and changes in

growing season and species distribution.

LA County DPH

Community Health

Improvement Plan

Every five years, DPH leads a community health planning effort to update its

Community Health Improvement Plan (CHIP). The CHIP is a collaborative

process of identifying health issues and ways to improve community conditions

over the long-term. DPH works with local partners to develop goals, objectives,

and strategies. To achieve the goals of the CHIP, DPH works with colleagues

both within and outside the traditional “health” sector.

2015 LA City and County

Plan for a Healthy Los

Angeles

Established seven goals surrounding public health issues, including: health

equity, city planning, parks and open spaces, food, environmental health,

education, and neighborhood safety. Most targets are set to be accomplished

either immediately, or within 2-4 years of the Plan adoption. Other jurisdictions

across the County have Health and Wellness Elements integrated within their

General Plans.

City of Santa Monica

Wellbeing Index

A measurement tool for understanding what contributes to wellbeing, and how

wellbeing differs by geography and demographic factors. This tool measures

six dimensions of wellbeing: outlook, community, place & planet, learning,

health, and economic opportunity.

City of El Monte Health

and Wellness Initiative

Promotes healthy lifestyles and physical activity, access to healthy food, public

safety and security, and access to recreation. This Plan established a walking

club that had over 350 residents actively enrolled, and created a 1-mile circuit-

walking path with mileage markers and signage connecting various civic,

education, retail, and health care facilities.


Los Angeles Food Policy

Council – Good Food

Purchasing Program

LA County’s Dept. of Public Health helped develop a food procurement model

that helps organizations and governments purchase food that is healthy,

sustainable, local, humane, and fair. Organizations that pledge to use this

model must meet 25 targets centered around sustainable procurement

techniques and healthy food preparation practices. The City of Los Angeles and

the LA Unified School District were among the first entities to pledge to the

GFPP.

County of Los Angeles -

Vision Zero

End all traffic deaths and serious injuries by implementing policies, programs,

and built environment interventions.

City of Los Angeles -

Vision Zero

End all traffic deaths and serious injuries by 2025 by implementing policies,

programs, and built environment interventions.

Regional

2016 Southern California

Council of Governments

(SCAG) Regional

Transportation

Plan/Sustainable

Communities Strategy

To improve public health, in 2016 SCAG established that it would protect the

environment health of residents by improving air quality and encourage active

transportation (e.g., bicycling and walking). This includes increasing bike trips

by 71% and walk trips by 28% region wide compared to bike and walk trips

taken in 2012.

SCAQMD Air Quality

Management Plan

Aims to promote new regulatory measures to implement an expected 30%

reduction of NOx from stationary sources in the 15-year period between 2008

and 2023

SCAQMD Voluntary

Incentives

SCAQMD will incentivize stationary and mobile source projects that will result in

emission reductions of NOx, voluntary organic compounds, and particulate

matter. The incentives would be issued for emission mitigation, reduced toxics

exposure, and new technology development and deployment that assist with

deployment of advanced clean technology and reduce air quality impacts in

environmental justice areas.

Electric Bus Pledges According to the Los Angeles County Electric Bus Coalition, formed by a group

of non-profits, Several county transit agencies—including LA Metro, LADOT,

Antelope Valley Transit, and Santa Monica’s Big Blue Bus, have pledged to work

towards 100% electric fleets.


L.A. County Board of

Supervisors

The Los Angeles County Board of Supervisors has prioritized prevention of

environmental health impacts throughout the County, with initiatives such as

the Oil and Gas Strike Team and the Toxic Threat Strike Team. The first

addresses the conditions, regulatory compliance, and potential public health

and safety risks associated with existing oil and gas facilities in the

unincorporated Los Angeles County. The second monitors and coordinates

inspections around environmental toxic sites around the county

State

Portrait of Promise: The

California Statewide Plan

to Promote Health and

Mental Health Equity

Lists many aspirational goals to be completed statewide by either 2018 or 2020.

Goals incorporate health and mental health equity into practices across

multiple types of health partners, public services, and disadvantaged

communities.

Health in All Policies Health in All Policies (HiAP) is a collaborative approach to incorporating health,

equity, and sustainability consideration into policymaking across sectors to

improve the health of all people. The approach is based on addressing the

social determinants of health as key drivers of health outcomes and health

inequities. The California Department of Health, in partnerships with the Public

Health Institute and the Strategic Growth Council, staff the California Health in

All Policies Task Force.

2017 General Plan

Guidelines (Environmental

Justice Element)

The State of California requires all cities and counties to develop local general

plans. These plans must focus on multiple public health-focused elements,

including environmental justice, safety, air quality, housing, and open space.

Let’s Get Healthy

California

This program sets multiple targets for a wide range of public health indicators,

including adult and childhood obesity, mental health problems, and chronic

disease, to be met by 2022. For example, the program aims to ensure that at

least 88% of California adults have consistent access to fresh fruits and

vegetables in their neighborhood. Also sets target of decreasing the percentage

of 7th graders who have constant feelings of sadness or hopelessness by 28%.

Finally sets the goal of decreasing the number of adults with diabetes to 7%.

CARB Mobile Source

Strategy

Envisions a broad strategy for reducing emissions from mobile sources

integrating cleaner vehicle technologies, energy sources, and fuels. Estimated

benefits include an 80% reduction in smog-forming emissions and a 45%

reduction in diesel particulate matter in the South Coast.


AB 617 (Garcia, 2017) AB 617 provides funds to address the disproportionate impacts of air pollution

in environmental justice communities. The measure requires local air districts,

like SCAQMD to take specific actions to reduce air pollution and toxic air

contaminants from commercial and industrial sources. In 2017, SCAQMD

received $10.7 million for community-level emissions reductions plans along

with monitoring and testing. The bill also includes new requirements for

enhanced fenceline and community monitoring in the vicinity of major

stationary sources such as refineries.

Community Air Protection

Program (CARB)

Under AB 617, this program works to implement community air monitoring and

community emissions reduction programs, and to address localized air

pollution through targeted incentive funding to deploy cleaner technologies in

these communities, as well as grants to support community participation in the

AB 617 process.

AB 134 (Committee on

Budget, 2017)

AB 134 funds community air quality projects, specifically clean vehicle and ports

investments.

National

2017-2022 Health Care

Preparedness and

Response Capabilities

The Office of the Assistant Secretary for Preparedness and Response published

a guideline for local governments to implement in their public health planning

processes. These are listed as four capabilities, including: foundation for

healthcare and medical readiness, health care and medical response

coordination, continuity of health care service delivery, and medical surge.

Healthy People 2020 This plan establishes 26 indicators organized under 12 overarching public health

topics, to be achieved by 2020. Topics include access to health services; clinical

preventive services; environmental quality; injury and violence; maternal, infant,

and child health; mental health; nutrition, physical activity, and obesity; oral

health; reproductive and sexual health; social determinants (high school

graduation rates); substance abuse; and tobacco use.


National Ambient Air

Quality Standards

(NAAQS)

Under the Clean Air Act, the NAAQS apply to several key air pollutants which

are regulated at the state level by AQMD. Much of Southern California is in non-

attainment (meaning areas consistently fail to meet standards) for several

NAAQS, including frequently for ozone and fine particulate matter. For the

South Coast Air Basin, it is estimated that oxides of nitrogen, one of the key

ingredients in ozone and fine particulate formation, must be reduced by around

80 percent from 2010 levels by 2023, and almost 90 percent by 2032 to meet

federal standards.


Endnotes i Haines, A. 2017. “Health co-benefits of climate action.” The Lancet, 1(1): PE4-#5.

ii Los Angeles County DPH, Key Indicators of Health (2017).

iii Map from Los Angeles County DPH, Highway to Health (2017).

iv Lewis, K. and S. Burd-Sharps. 2018. A Portrait of Los Angeles County. Measure of America of the Social Science Research

Council. Retrieved from: https://ssrc-static.s3.amazonaws.com/moa/PoLA%20Full%20Report.pdf

vv Lewis, K. and S. Burd-Sharps. 2018. A Portrait of Los Angeles County. Measure of America of the Social Science Research


vi Lewis, K. and S. Burd-Sharps. 2018. A Portrait of Los Angeles County. Measure of America of the Social Science Research


vii Lewis, K. and S. Burd-Sharps. 2018. A Portrait of Los Angeles County. Measure of America of the Social Science Research


viii Data from Los Angeles County DPH, Mortality in Los Angeles County (2013).

ix California Department of Public Health. 2016. “Burden of Cardiovascular Disease in California.” Chronic Disease Control

Branch. Retrieved from: https://www.cdph.ca.gov/Programs/CCDPHP/DCDIC/CDCB/CDPH%20

Document%20Library/CVDBurdenReport2016_ADA.pdf

x Data from Los Angeles County DPH, Mortality in Los Angeles County (2013).

xi County of Los Angeles Department of Public Health. 2011. Obesity and Related Mortality in Los Angeles County. Office of

Health Assessment and Epidemiology. Retrieved from: http://publichealth.lacounty.gov/ha/

reports/habriefs/2007/Obese_Cities/Obesity_2011Fs.pdf

xii Data from Los Angeles County DPH, Key Indicators of Health (2017). State overall data on diabetes from Let’s Get Healthy California (2016). State overall data on cardiovascular disease (2000-2014) from California Department of Public Health,

“Burden of Cardiovascular Disease” (2016). . xiii Data from Los Angeles County DPH, “Los Angeles County Infant Mortality, Preterm Births, and Birthweight Fact Sheet (2013). State overall data on preterm birth and birth weight (2007) from Healthy People 2020.

xiv Singh, A.S. and et. al. (2008). “Tracking of childhood overweight into adulthood: a systematic review of the literature. Obesity

Reviews, 9(5): 474-88. xv Data from Los Angeles County DPH, Community Health Services. xvi Chisholm, D. 2013. Investing in Mental Health: Evidence for Action. World Health Organization. Retrieved from: http://apps.who.int/iris/bitstream/handle/10665/87232/9789241564618_eng.pdf;jsessionid=3AC35E1EDFCC3B4C46D26EA3CADC8664?sequence=1

xvii Data from Los Angeles County DPH, Key Indicators of Health (2017). State overall data on depression (2015) from Let’s Get Healthy California (2016).

xviii Los Angeles County Department of Public Health. 2015. Los Angeles County Health Survey. Retrieved from:

http://publichealth.lacounty.gov/ha/LACHSDataTopics2015.htm xix Centers for Disease Control and Prevention. 2016. “Well-being Concepts.” Retrieved from: https://www.cdc.gov/hrqol/wellbeing.htm#three


xx Data from Los Angeles County DPH, Key Indicators of Health (2017). State overall data on depression (2015) from Let’s Get Healthy California (2016). xxi Chetty, R. and et. al. 2016. “The Association Between Income and Life Expectancy in the United States, 2001-2014.” JAMA, 315(16): 1750-1766. xxii Robert Wood Johnson Foundation. 2011. “Income, Wealth, and Health.” Retrieved from: https://www.rwjf.org/content/dam/farm/reports/issue_briefs/2011/rwjf70448

xxiii Public Policy Institute of California. 2018. California Poverty by County. Retrieved from: http://www.ppic.org/map/

california-poverty-by-county-and-legislative-district/

xxiv Lewis, K. and S. Burd-Sharps. 2018. A Portrait of Los Angeles County. Measure of America of the Social Science Research

Council. Retrieved from: https://ssrc-static.s3.amazonaws.com/moa/PoLA%20Full%20Report.pdf xxv Data from Robert Wood Johnson Foundation, County Health Rankings and Roadmap (2018).

xxvi Modified from Measure of America’s A Portrait of Los Angeles County (2018).

xxvii Modified from Southern California Public Health Alliance, Healthy Places Index (2018).

xxviii Office of Environmental Health Hazard Assessment. 2018. CalEnviroScreen 3.0. Retrieved from: https://oehha.ca.

gov/calenviroscreen/report/calenviroscreen-30

xxix Map from OEHHA, CalEnviroScreen 3.0 (2018).

xxx Federico, Rauser, and Gold, “2017 Sustainable LA Environmental Report Card for Los Angeles County: Energy & Air

Quality.”

xxxi Federico, Rauser, and Gold.

xxxii Environmental Protection Agency, https://www.epa.gov/ozone-pollution/health-effects-ozone-pollution

xxxiii Environmental Protection Agency, https://www3.epa.gov/region1/airquality/pm-human-health.html

xxxiv http://www.latimes.com/local/california/la-me-freeway-pollution-what-you-can-do-20171230-htmlstory.html

xxxv Federico, Rauser, and Gold.

xxxvi Federico, Rauser, and Gold.

xxxvii Data from Los Angeles County DPH, LA County Health Survey (2015).

xxxviii Map from Southern California Public Alliance, Healthy Places Index (2018).

xxxix Los Angeles County Department of Public Health. 2016. Parks and Public Health in Los Angeles County A Cities and Communities Report. Retrieved from: http://publichealth.lacounty.gov/chronic/docs/Parks%20Report%202016-

rev_051816.pdf xl Los Angeles County Department of Public Health. Parks and Public Health in Los Angeles County: A Cities and Communities Report; May 2016.

xliUnited States Department of Agriculture. 2018. “Ranges of Food Security and Food Insecurity.” Retrieved from: https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us/definitions-of-food-security.aspx

xlii Los Angeles County Department of Public Health. 2017. “Food Insecurity in Los Angeles .” Retrieved from: https://

www.lafoodbank.org/wp-content/uploads/FINAL_LA-Health_FoodInsecurity_Sept-2017.pdf

xliii Data from Los Angeles County, LA County Health Survey (2015).

xliv Zenk, S.N., et. al. 2009. “Neighborhood Retail Food Environment and Fruit and Vegetable Intake in a Multiethnic Urban

Population.” American Journal of Health Promotion, 23(4), pp. 255-264.


xlv University of California Los Angeles. 2008. Designed for Disease: The Link Between Local Food Environments and Obesity and Diabetes. Retrieved from http://www.healthpolicy.ucla.edu/pubs/Publication.aspx?pubID=250.

xlvi Data from Community Commons, Modified Retail Food Environmental Index Score (2011).

xlvii Public Policy Institute of California. 2018. The Affordable Care Act in California. Retrieved from: http://

www.ppic.org/publication/the-affordable-care-act-in-california/

xlviii County of Los Angeles Department of Public Health. 2017. “Recent Trends in Health Insurance Coverage.” Retrieved from:

http://publichealth.lacounty.gov/docs/LaHealth_RecentTrendsInHealth InsuranceCoverage_yr2017.pdf

xlix Lucia, L,, Dietz, M., and et al. 2017. “Fact Sheet: What does Los Angeles County Stand to Lose under ACA Repeal?.” UCLA

Center for Health Policy Research and UC Berkeley Labor Center. Retrieved from: http://laborcenter.Berkeley.edu/

pdf/2017/Los-Angeles-County-Fact-Sheet.pdf

l Modified from Los Angeles County DPH, Los Angeles County Recent Trends in Health Insurance Coverage (2017)

li Los Angeles County Department of Public Health. 2017. “Key Indicators of Health by Service Planning Area.” Office of

Health Assessment & Epidemiology and Health Assessment Unit. Retrieved from: http://publichealth.lacounty.

gov/ha/docs/2015LACHS/KeyIndicator/PH-KIH_2017-sec%20UPDATED.pdf

lii Data from Los Angeles County DPH, LA County Health Survey (2015). liii U.S. Global Change Research Program, Climate and Health Assessment (2016).

liv U.S. Global Change Research Program, Climate and Health Assessment (2016).

lv Data from Fengpeng S, et al., UCLA (2015). Note: Higher Scenario (RCP 8.5), Coupled Model Intercomparison Project

(CMIP5).

lvi Urban Sustainability Director’s Network and Raimi + Associates, Guide to Equitable, Community-Driven Climate Preparedness (2017).

lvii Data from Los Angeles County DPH, LA County Health Survey (2015).

lviii Agrawal, N. 2018. “L.A. County to consider temporary measure to cap rent increases.” Retrieved from:

http://www.latimes.com/local/lanow/la-me-ln-rent-control-20180911-story.html

lix Peterson, M. 2016. “LA officials use green infrastructure to fight stormwater pollution.” KPCC Southern California Radio.

Retrieved from: https://www.scpr.org/news/2010/09/03/18931/la-stormwater/ lx Prevention Institute. 2017. A Time of Opportunity: Water, Health, and Equity in the Los Angeles Region.

lxi http://www.scag.ca.gov/Documents/f2008RCP_SolidWaste.pdf

lxii Kim, J. J., et. al. 2004. “Traffic-related Air Pollution near Busy Road: The East Bay Children’s Respiratory Health Study.”

American Journal of Respiratory and Critical Care Medicine: 170(5), pp. 520-526.

lxiii Daisa, J. M. and Peers, J. B. 2010. “Narrow Residential Streets: Do They Really Slow Down Speeds?” Institute of

Transportation Engineers. Retrieved from http://www.ite.org/traffic/documents/AHA97F46.pdf.

lxiv Anderson, R. W. G, et. al. 1997. “Vehicle Travel Speeds and the Incidence of Fatal Pedestrian Crashes.” Accident Analysis and Prevention, 29(5), pp. 667-674.

lxv Litman. T. 2010. “Evaluating Public Transportation Health Benefits.” Victoria Transport Policy Institute for the American

Public Transportation Association. Retrieved from: http://www.apta.com/resources/reportsandpublications/Documents/

APTA_Health_Benefits_Litman.pdf.


lxvi Cohen, L. and A. Dupuy. 2017. “California Ups the Ante With Billion-Dollar Active Transportation Plan.” Retrieved from:

https://www.railstotrails.org/trailblog/2017/june/05/california-ups-the-ante-with-billion-dollar-active-transportation-plan/

lxvii On the Move: Southern California Delivers the Goods. http://www.rctcdev.info/uploads/media_items/freight-brochure-

2015-0121-r7.original.pdf

lxviii Dillon, L. 2018. “California to rely on 100% clean electricity by 2045 under bill signed by Gov. Jerry Brown.” Los Angeles Times. Retrieved from: http://www.latimes.com/politics/la-pol-ca-renewable-energy-law-signed-20180910-story.html

lxix California’s Fourth Climate Change Assessment, http://www.climateassessment.ca.gov/regions/docs/20180827-

LosAngeles.pdf

http://www.climateassessment.ca.gov/regions/docs/20180827-LosAngeles.pdf

http://www.climateassessment.ca.gov/regions/docs/20180827-LosAngeles.pdf